Obesity Is Increasing in Liver Transplant Recipients and Exacerbates Cardiovascular Risk: A Single-Centre European Study

Recent changes in the profile of liver transplant (LT) recipients include an increasing number of patients with metabolic-associated steatotic liver disease (MASLD), which is associated with obesity and cardiovascular risk. We aimed to investigate the trend in the presence of obesity among LT recipients and its association with cardiovascular risk.

Single-centre retrospective study, which included LT recipients between 2015 and 2020. Obesity and patient’s demographic were assessed before LT and 12 months thereafter. Cardiovascular risk factors including ASCVD score were recorded and compared between patients with and without obesity.

During the study period, 358 LT were performed. The mean BMI before LT significantly increased over time during the study period (p_trend = 0.04). Pre-LT, patients with obesity were older and had a higher prevalence of MASLD, diabetes, hypertension and dyslipidaemia. Twelve months after LT, most patients gained weight, although mean BMI did not significantly increase over time (p_trend = 0.072). LT recipients with obesity 12 months after LT more frequently presented with diabetes and hypertension and had higher ASCVD score than LT recipients with BMI < 30 kg/m². One-year mortality was similar between patients with or without obesity before LT (p = 0.816).

In the past few years, there has been a significant increase in the prevalence of obesity in LT recipients. LT recipients with obesity present a higher cardiovascular risk as assessed by the presence of cardiovascular risk factors and the ASCVD score. Our results may be useful when designing strategies to directly target obesity and weight management in this population.